Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer Journal Article
| Authors: | Gondo, T.; Hricak, H.; Sala, E.; Zheng, J.; Moskowitz, C. S.; Bernstein, M.; Eastham, J. A.; Vargas, H. A. |
| Article Title: | Multiparametric 3T MRI for the prediction of pathological downgrading after radical prostatectomy in patients with biopsy-proven Gleason score 3 + 4 prostate cancer |
| Abstract: | Objectives: The aim of this study was to assess the diagnostic performance of pre-treatment 3-Tesla (3T) multiparametric magnetic resonance imaging (mpMRI) for predicting Gleason score (GS) downgrading after radical prostatectomy (RP) in patients with GS 3 + 4 prostate cancer (PCa) on biopsy. Methods: We retrospectively reviewed 304 patients with biopsy-proven GS 3 + 4 PCa who underwent mpMRI before RP. On T2-weighted imaging and three mpMRI combinations (T2-weighted imaging + diffusion-weighted imaging [DWI], T2-weighted imaging + dynamic contrast-enhanced-MRI [DCE-MRI], and T2-weighted imaging + DWI + DCE-MRI), two radiologists (R1/R2) scored the presence of a dominant tumour using a 5-point Likert scale (1 = definitely absent to 5 = definitely present). Diagnostic performance in identifying downgrading was evaluated via areas under the curves (AUCs). Predictive accuracies of multivariate models were calculated. Results: In predicting downgrading, T2-weighted imaging + DWI (AUC = 0.89/0.85 for R1/R2) performed significantly better than T2-weighted imaging alone (AUC = 0.72/0.73; p < 0.001/p = 0.02 for R1/R2), while T2-weighted imaging + DWI + DCE-MRI (AUC = 0.89/0.84 for R1/R2) performed no better than T2-weighted imaging + DWI (p = 0.48/p > 0.99 for R1/R2). On multivariate analysis, the clinical + mpMRI model incorporating T2-weighted imaging + DWI (AUC = 0.92/0.88 for R1/R2) predicted downgrading significantly better than the clinical model (AUC = 0.73; p < 0.001 for R1/R2). Conclusion: mpMRI improves the ability to identify a subgroup of patients with Gleason 3 + 4 PCa on biopsy who are candidates for active surveillance. DCE-MRI (compared to T2 + DWI) offered no additional benefit to the prediction of downgrading. Key Points: • Diagnostic performance of T2-weighted-imaging + DWI was better than T2-weighted-imaging alone. • Diagnostic performance of T2-weighted-imaging + DWI was similar to T2-weighted-imaging + DWI + DCE-MRI. • Combining clinical and T2-weighted-imaging + DWI features best predicted GS downgrading. • mpMRI might prevent overtreatment by increasing eligibility for PCa active surveillance. |
| Keywords: | adult; human tissue; aged; major clinical study; histopathology; nuclear magnetic resonance imaging; prostate specific antigen; patient monitoring; retrospective study; prediction; prostate cancer; gleason score; radiologist; prostatectomy; active surveillance; contrast enhancement; prostate biopsy; multivariate analysis; diffusion weighted imaging; dynamic contrast-enhanced mri; nuclear magnetic resonance scanner; diffusion-weighted imaging; human; male; article; multiparametric mri |
| Journal Title: | European Radiology |
| Volume: | 24 |
| Issue: | 12 |
| ISSN: | 0938-7994 |
| Publisher: | Springer |
| Date Published: | 2014-12-01 |
| Start Page: | 3161 |
| End Page: | 3170 |
| Language: | English |
| DOI: | 10.1007/s00330-014-3367-7 |
| PROVIDER: | scopus |
| PUBMED: | 25100337 |
| DOI/URL: | |
| Notes: | Export Date: 2 January 2015 -- Source: Scopus |
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